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Despite the continual conversations and protests from payers and some health systems claiming their patients can't understand transparency with insurance plans and pricing, health plans have a member communication problem, a new study says.

While communication issues may not be mutually exclusive to pricing transparency, it seems there's a much bigger cultural issue. According to consumers interviewed by J.D. Power, consumer attitudes toward commercial health plans found that as many as 60% of private plan members say their insurers never contacted them regarding the virus.

“Health plans are widely perceived as lacking a customer-centric mindset and not putting the best interests of their members first,” said James Beem, managing director, global healthcare intelligence at J.D. Power. “The COVID-19 pandemic has amplified these shortcomings, but they are not new. If traditional health insurance plans want to resist the threat from disruptors, they need to demonstrate partnership with members—and on behalf of employers—to improve member health, reduce costs and help members navigate the healthcare system.”

Additionally, nearly 50% (48%) said they feel their insurer has not shown concern for their health since the pandemic reached U.S. shores. That’s a pretty significant disconnect between patient perception and insurer desired outcomes.

J.D. Power says this gap between member expectations and how health plans view their role remains a critical concern. “Consumers want a coordinated, integrated experience that their health plan may be unwilling or unable to provide,” FierceHealthcare reported.

Telehealth is one of the most significant opportunities where communication has faltered. According to the survey, less than 10% of plan members say they used telehealth in the past. This fact is relevant because almost half of plan members would consider using telehealth if it was covered and if they knew the service was offered by their health plan.

Perhaps even more expository from the survey is that 75% of consumers know about telehealth’s capabilities. Still, a majority (54%) told J.D. Power that they don’t understand if their insurer offers and allows coverage of such benefits.

The one takeaway from the survey is that health insurance companies are not appropriately engaging or communicating with their customers. Because of this disconnect in communication, many insured consumers cannot assign the proper value for the dollars spent on their health insurance products.

Additional key points from the study include:

Health plans lack customer centricity: Just 36% of commercial health plan members say their health plan acts in their best interest “always” or “most of the time,” and just 25% of members say they view their health plan as a trusted partner in their health and wellness. This lack of a customer-centric positioning results in an overall satisfaction score this year for commercial health plans of 719 (on a 1,000-point scale), among the lowest of all industries evaluated by J.D. Power.

Customer satisfaction directly linked to customer engagement: Proactive efforts by health plans to engage with members — by providing advice on how to control costs or helping to coordinate care — drive significant improvement in overall customer satisfaction. For example, when a health plan helps members keep out-of-pocket costs low, the average overall satisfaction score is 819, which is 152 points higher than when no such effort is made.

Telehealth growth creates a wildcard opportunity: Expanding telehealth usage is associated with a 39-point increase in overall customer satisfaction. Additionally, with telehealth utilization surging since the COVID-19 pandemic began, J.D. Power projects this trend will continue to proliferate. According to this study, which was mainly fielded before the COVID-19 pandemic hit the United States, just 9% of commercial health plan members have used telehealth. Of those who have not, 48% say they would consider using it if their plan covered it.

The study also measures customer satisfaction with commercial member health plans in 21 geographic regions.

The U.S. Commercial Member Health Plan Study, now in its 14th year, measures satisfaction among members of 149 health plans.

About the Author

Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.